重症患者念珠菌菌种分布及卡泊芬净敏感性分析

中国真菌学杂志　 2018, Vol. 13 　Issue (1): 20-23.

重症患者念珠菌菌种分布及卡泊芬净敏感性分析

李方义¹, 张静², 邹子俊¹, 易修文², 李伟超¹, 周林¹, 郑煜凯¹, 何志捷¹

1. 中山大学孙逸仙纪念医院重症医学科, 广州 510120;
2. 中山大学孙逸仙纪念医院皮肤科, 广州 510120

收稿日期:2017-08-06 出版日期:2018-02-28 发布日期:2018-02-28
通讯作者: 何志捷,E-mail:hezhijie2004@126.com E-mail:hezhijie2004@126.com
作者简介:李方义,女(汉族),硕士,住院医师.E-mail:lfyhnxn@126.com
基金资助:
中华医学会临床医学科研专项资金（1430310568）；广东省部产学研项目（2012B091100456）

Distribution and in vitro antifungal susceptibilities to caspofungin of Candida species isolated from critical ill patients

LI Fang-yi¹, ZHANG Jing², ZOU Zi-jun¹, YI Xiu-wen², LI Wei-chao¹, ZHOU Lin¹, ZHENG Yu-kai¹, HE Zhi-Jie¹

1. Department of intensive care unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120;
2. Department of dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120

Received:2017-08-06 Online:2018-02-28 Published:2018-02-28

摘要/Abstract

摘要：

目的评估中山大学孙逸仙纪念医院重症医学科重症患者念珠菌菌种分布及卡泊芬净敏感性，以指导临床抗真菌药物的合理使用。方法收集2015年2月1日~2016年2月1日入住我院重症医学科3 d以上的所有成年重症患者的念珠菌菌株进行菌种鉴定，卡泊芬净敏感性检测采用临床和实验室标准化委员会（Clinical and Laboratory Standards Institute，CLSI）酵母菌液基稀释法（M27-A3）进行。结果共收集念珠菌菌株76株，白念珠菌37株，占48.7%。其次为热带念珠菌20株（26.3%）、近平滑念珠菌8株（10.5%）、光滑念珠菌8株（10.5%）；克柔念珠菌、葡萄牙念珠菌、季也蒙念珠菌各1株。绝大部分念珠菌菌株对卡泊芬净敏感，敏感率为94.7%。其中，分离到卡泊芬净耐药的光滑念珠菌1株、卡泊芬净中介的光滑念珠菌2株、白念珠菌1株。结论我院重症医学科重症患者念珠菌仍以白念珠菌最常见。非白念珠菌中热带念珠菌的比例较高。来自于重症患者的念珠菌对卡泊芬净仍具有较好的敏感性。

关键词: 重症患者, 卡泊芬净, 侵袭性真菌病, 耐药性分析

Abstract:

Objective To investigate the distribution and in vitro activity of isolates of Candida from critical ill patients of general intensive care unit (ICU), aiming to guide the selection of antifungal. Methods All Candida isolates were taken from adult critical ill patients of general ICU from Sun Yat-sen Memorial Hospital, Sun Yat-sen University, with ICU stay more than 3 days during February 2015 between February 2016 were identified and then tested for susceptibility to caspofungin using the CLSI M27-A3 broth microdilution method. Results 76 isolates of Candida were collected. 37 isolates of Candida spp, accounted for 48.7%, 20 isolates of C. tropicalis (26.3%), 8 isolates of C. glabrata and 8 isolates of C. parapsilosis (10.5%). 1 isolates of C.krusei, C.guilliermondii and C.lusitaniae each. Candida spp. remains high susceptibility to caspofungin (94.7%) in general ICU from Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Resistance was found in 1 C.glabrata isolate, intermediate were found in 2 C.glabrata isolates and 1 C.albicans isolate. Conclusions C. albicans was the most commonly species among critical ill patients of general ICU from Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The most frequently identified species of non-C.albicans is C.tropicalis. Most Candida spp. isolates remain high susceptibility to caspofungin in critical ill patients.

Key words: critically ill patient, caspofungin, invasive fungal disease, resistance of fungi

中图分类号:

R519.3

李方义, 张静, 邹子俊, 易修文, 李伟超, 周林, 郑煜凯, 何志捷. 重症患者念珠菌菌种分布及卡泊芬净敏感性分析[J]. 中国真菌学杂志, 2018, 13(1): 20-23.

LI Fang-yi, ZHANG Jing, ZOU Zi-jun, YI Xiu-wen, LI Wei-chao, ZHOU Lin, ZHENG Yu-kai, HE Zhi-Jie. Distribution and in vitro antifungal susceptibilities to caspofungin of Candida species isolated from critical ill patients[J]. Chinese Journal of Mycology, 2018, 13(1): 20-23.

参考文献

[1] Yapar N. Epidemiology and risk factors for invasive candidiasis[J]. Ther Clin Risk Manag, 2014, 10(95):105.
[2] Calandra T, Roberts JA, Antonelli M, et al. Diagnosis and management of invasive candidiasis in the ICU:an updated approach to an old enemy[J]. Crit Care, 2016, 20(1):125.
[3] Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained:a potential risk factor for hospital mortality[J]. Antimicrob Agents Chemother, 2005, 49(9):3640-3645.
[4] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2015, 62(4):e1-50.
[5] Pfaller M, Boyken L, Hollis R, et al. In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin, and micafungin:six years of global surveillance[J]. J Clin Microbiol, 2008, 46(1):150-156.
[6] Pfaller MA, Castanheira M, Messer SA, et al. In vitro antifungal susceptibilities of isolates of Candida spp. and Aspergillus spp. from China to nine systemically active antifungal agents:data from the SENTRY antifungal surveillance program, 2010 through 2012[J]. Mycoses, 2015, 58(4):209-214.
[7] Kullberg BJ, Arendrup MC. Invasive candidiasis[J]. N Engl J Med, 2015, 373(15):1445-1456.
[8] Guo F, Yang Y, Kang Y, et al. Invasive candidiasis in intensive care units in China:a multicentre prospective observational study[J]. J Antimicrob Chemother, 2013, 68(7):1660-1668.
[9] Wang H, Xiao M, Chen SC, et al. In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010 National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study[J]. J Clin Microbiol, 2012, 50(12):3952-3959.
[10] Yesudhason BL, Mohanram K. Candida tropicalis as a predominant isolate from clinical specimens and its antifungal susceptibility pattern in a tertiary care hospital in Southern India[J]. J Clin Diagn Res, 2015, 9(7):DC14-16.
[11] Tan BH, Chakrabarti A, Li RY, et al. Incidence and species distribution of candidaemia in Asia:a laboratory-based surveillance study[J]. Clin Microbiol Infect, 2015, 21(10):946-953.
[12] Alexander BD, Johnson MD, Pfeiffer CD, et al. Increasing echinocandin resistance in Candida glabrata:clinical failure correlates with presence of FKS mutations and elevated minimum inhibitory concentrations[J]. Clin Infect Dis, 2013, 56(12):1724-1732.
[13] Arendrup MC, Perlin DS. Echinocandin resistance:an emerging clinical problem[J]. Curr Opin Infect Dis, 2014, 27(6):484-492.
[14] Perlin DS. Echinocandin resistance in Candida[J]. Clin Infect Dis, 2015, 61(suppl 6):S612-S617.
[15] Vallabhaneni S, Cleveland AA, Farley MM, et al. Epidemiology and risk factors for echinocandin nonsusceptible Candida glabrata bloodstream infections:data from a large multisite population-based candidemia surveillance program, 2008-2014[C]. Open Forum Infect Dis, 2015, 2
[4]:ofv163.
[16] Farmakiotis D, Tarrand JJ, Kontoyiannis DP. Drug-resistant Candida glabrata infection in cancer patients[J]. Emerg Infect Dis, 2014, 20(11):1833-1840.
[17] Fothergill AW, Mccarthy DI, Albataineh MT, et al. Effects of treated versus untreated polystyrene on caspofungin in vitro activity against Candida species[J]. J Clin Microbiol, 2016, 54(3):734-738.